Chen Hao, Chu Ling-Yu, Li Xiao-Hui, Peng Yu-Hui, Liu Can-Tong, Tian Li-Ru, Xie Jian-Jun, Xu Yi-Wei
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Department of Biochemistry and Molecular Biology, Shantou University Medical College, Shantou, China.
Front Oncol. 2020 Apr 24;10:610. doi: 10.3389/fonc.2020.00610. eCollection 2020.
Primary small cell carcinoma of the esophagus (SCCE) is a rarely aggressive disease characterized by rapid progression, widespread metastasis, and poor prognosis. This study was aimed to evaluate the prognostic significance of serum lipids for overall survival (OS) in SCCE patients. We retrospectively analyzed SCCE patients in a training cohort (61 patients) and validated them in a validation cohort (27 patients). These cases were collected from Sun Yat-sen University Cancer Center from 2006 to 2017. Univariate and multivariate Cox survival analyses were performed to determine serum lipids as prognostic factors associated with the patient's OS. Time-dependent receiver operating characteristics (ROC) were used to compare predictive power of independent prognostic factors. The predictive accuracy and discriminative ability of the prognostic factors were measured by the concordance index (C-index) and decision curve, and were compared with the TNM stage system. On multivariate analysis of the training cohort, independent factors for survival were gender, BAR (ApoB/ApoA-1) and TNM stage. The area under the curve (AUC) of BAR+TNM stage in the training cohort was higher than that of TNM stage for OS, and similar result was observed in the validation cohort. The c-index of BAR+TNM stage for predicting the OS was 0.655 (95% CI = 0.571-0.740), which was higher than that of TNM stage [0.614 (95% CI = 0.530-0.698)] in the training cohort. In the validation cohort, the C-index of the BAR+TNM stage for predicting OS was also higher than that of the TNM stage [0.688 (95% CI: 0.5700.806) vs. (0.512; 95% CI: 0.3920.632)]. In addition, decision curve analysis also showed that the predictive accuracy of BAR+TNM stage for OS was higher than TNM stage both in the training and the validation cohorts. BAR represents a promising prognostic indicator that might complement TNM stage in the prognosis of SCCE, and that warrant further assessment in large SCCE patient cohort.
原发性食管小细胞癌（SCCE）是一种侵袭性很强的疾病，其特点是进展迅速、广泛转移且预后较差。本研究旨在评估血清脂质对SCCE患者总生存期（OS）的预后意义。我们回顾性分析了一个训练队列中的SCCE患者（61例），并在一个验证队列（27例）中进行了验证。这些病例于2006年至2017年从中山大学肿瘤防治中心收集。进行单因素和多因素Cox生存分析以确定血清脂质作为与患者OS相关的预后因素。使用时间依赖性受试者工作特征（ROC）来比较独立预后因素的预测能力。通过一致性指数（C指数）和决策曲线测量预后因素的预测准确性和判别能力，并与TNM分期系统进行比较。在训练队列的多因素分析中，生存的独立因素为性别、BAR（载脂蛋白B/载脂蛋白A-1）和TNM分期。训练队列中BAR+TNM分期的曲线下面积（AUC）高于TNM分期对OS的曲线下面积，在验证队列中也观察到类似结果。BAR+TNM分期预测OS的C指数为0.655（95%CI = 0.571-0.740），高于训练队列中TNM分期的C指数[0.614（95%CI = 0.530-0.698）]。在验证队列中，BAR+TNM分期预测OS的C指数也高于TNM分期[0.688（95%CI：0.5700.806）对（0.512；95%CI：0.3920.632）]。此外，决策曲线分析还表明，在训练和验证队列中，BAR+TNM分期对OS的预测准确性均高于TNM分期。BAR是一个有前景的预后指标，可能在SCCE的预后中补充TNM分期，并且需要在大型SCCE患者队列中进行进一步评估。
